Australasian Society of
Career Medical Officers
www.
ascmo.org.au
Hospital Skills Program
Uploaded to ASCMO website on 16th February 2007
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Disclaimer
Hospital Skills Program
The NSW Institute of Medical Education and Training (IMET) is seeking feedback on the draft version of a Hospital Skills Program Curriculum.
ASCMO (& IMET) are interested in comments from CMOs. Please view the following documents, and send your comments
to Dr Michael Boyd (ASCMO's President) by email
to stringhouse@optusnet.com.au:
1. Hospital Skills Program - Official Draft Handout - 13 Feb 2007 [280K Word doc]
2. OFFICIAL INDIVIDUAL FEEDBACK [70K Word doc]
3. OFFICIAL TABLE DISCUSSION QUESTIONS [150K Word doc]
4. Hospital Skills Program Curriculum Framework Feb2007 [500K pdf]
BACKGROUND:
The Institute of Medical Education and Training (IMET) has been working
towards creating a training program for CMO's, Locums and General
Practitioners who work in Emergency Departments. Through much
discussion and hard work they have evolved a structure which builds upon
Junior Medical Officers training. The aim is to have collaborative
curriculum based training, without barriers, and to utilise the CMO
Award as the basis for rewarding the attainment of each level.
This is an important advance and may be a first step in the achievement
of a career path for CMO's. CMO's have been asked to critique the
effort and to advance ideas to make it better. Please take some time to
look at the documents and return comments via ASCMO-talk, our Secretary
Cathy or direct to myself. Alternatively feel free to contact IMET
directly.
Dr Michael Boyd , President ASCMO
Currently a problem has been identified.
A problem with amount and certification of skills in a disparate group of clinicians (CMOs, GPs & Locums) that is located peripherally in both geography, time and organisation; in a system that has a top down approach to provision of organisation, information, resources, and education.
The proposed model to fix this is a poorly resourced top down model with one education support officer applied centrally.
Teaching resources are most concentrated centrally, eg teaching hospitals that are already training registrars, and have few CMOs and OTDs who might be in positions of need. These teaching resources are multiple FACEMS in a dept., some of whom will be good teachers, skills workshops, conferences, meetings, simulations, and there is more scope to get cover when a teaching event is happening.
The problem is most evident at peripheral locations where there are staff shortages, only one person in a role eg one FACEM who may not be a good teacher and has many other things competing for their non-clinical time and the FACEM is only on day shift, where there are more CMOs, and more of them on at non central times, and possibly containing more of the people that we most need to educate. The problem will also be most evident in those that inhabit peripheral times, weekends and nights.
How to have effect?
Another top down approach, with minimal resourcing will get nothing out to the periphery, which is where the problem is thought to be most evident. By all means establish the committees and representatives and directors of training, but it wont fix the problem, it is just bureaucracy's for administrative support. It will help in capturing the increased number of PGY3s that will soon begin flowing into the system, and reduce the risk of some of them following a path to isolation and not acquiring skills.
What will reach peripherally?
There needs to be a peripheral injection of resources and energy to be able to get the most benefit to the places that need it most. Where morale is flagging, and doing extra, and travelling further to do it is not going to happen.
A different solution is a truck with an enthusiastic educator, and a locum doctor. In the truck are suitable skill stations and simulators and other education resources. After suitable prior promotion the truck arrives, the locum takes over ED workload (as in many target places there is not spare staff to cover while education sessions happen, or the CMOs are the ones that cover while interns, residents and registrars are educated) and then some education sessions can occur, ideally at shift change to cover the maximum amount of staff. This would not do all of everything, but it would be a way of injecting some energy and improvements where it is most needed and then work in centrally, rather than the other way around. The educators would be in a position to rate how different locations are, and could help in targeting further delivery. The educator would probably best be a person with a particular interest in a particular topic, and a flair for education. It would probably be best to rotate people through the education position to have a variety of educators each with their own pet topics, released from usual location and position for the day or week.
By making it cost neutral to the FACEM, their department, and their hospital, some barriers to participation would be removed, so the health department would need to fund the time spent as educators.
For many sessions the truck may only need to be a car, the educator, the locum doctor, a box of props for that session, (possibly a laptop, and a data projector). Up to 3-4 sessions could be done in a day, 20 per week, 2,000 per year. This could be 1 session per month at each of the 140 odd hospitals in the state, and if more targeted one every 2 weeks. Most sessions and educators are probably best organised at an area level, but a good collection of simulators and skill stations would be invaluable for the hospital system and components of this system could be available to the educators.
Once resources are know then less would be required to be carried in and a standardised education room could be built up to facilitate.
Costing
- one Full-time equivalent (FTE) for educator
- one Full-time equivalent (FTE) for locum
- vehicle expenses
- education resources
This proposal would delivery education where it is most needed, using people who have already developed lessons/modules, that could then be deployed over many sites rather than just at their own site. It also brings outside people into failing sites and provides some comparison between different peripheral sites.
